The review of the literature focuses on the coping and psychological state step in the model of illness, the step at which the cascade of events can be influenced by the social worker. The purpose is to identify the psychological states or coping behaviors that are associated with immune system suppression and those that are associated with immune system enhancement. The implication is that social workers should encourage those outlooks or psychological states associated with immune enhancement and should discourage those associated with immune suppression. In addition to the general findings on how psychological factors relate to health, some specific studies conducted in samples of people with the AIDS virus are discussed. These studies too have shown that influencing psychological factors can affect the immune system in people with HIV who are asymptomatic and people with AIDS (PWAs). Extrapolating from these studies, interventions that will be useful for these people can be generated. STRESS AND THE IMMUNE SYSTEM: IMPAIRMENT OF FUNCTIONING Many of the initial studies exploring the impact of uncontrollable stress on the immune system examined the effects of stress in rodents. The investigators subjected rodents to unpredictable, uncontrollable shocks and studied subsequent responses. Following exposure to this procedure, rats behaved in a learned helpless fashion: They failed to act to escape subsequent, controllable shock (Seligman, 1991). Further, learned helpless animals were immunosuppressed. Their white blood cells (both T and B cells) exhibited attenuated division and proliferation when provoked by an appropriate stimulus. Their natural killer cells, the first line of defense against viral-infected and tumor cells, were less active (Laudenslager, Ryan, Drugan, Hyson, & Maier, 1983; Millar, Thomas, Pacheco, & Rollwagen, 1993; Shavit et al., 1985). Intrigued by the immune system suppression findings, investigators sought to ident...
